Provider Demographics
NPI:1770326332
Name:WOLTER, KAYLIN (DMD)
Entity type:Individual
Prefix:DR
First Name:KAYLIN
Middle Name:
Last Name:WOLTER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:877 E 16TH ST STE 30
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-9426
Mailing Address - Country:US
Mailing Address - Phone:616-396-5197
Mailing Address - Fax:
Practice Address - Street 1:877 E 16TH ST
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-9425
Practice Address - Country:US
Practice Address - Phone:616-396-5197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29016021761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice